The grades of evidence (I-III) and levels of recommendation (A-C) are defined at the end of the "Major Recommendations" field.
The following recommendations are based on good and consistent scientific evidence (Level A):
- Antiviral therapy should be prescribed at the first clinical episode to reduce the duration of symptoms and viral shedding.
- Women should be offered antiviral treatment for recurrent episodes at prodrome or at the beginning of an episode of genital herpes.
- Women with frequent recurrences should be offered suppressive therapy.
- For couples in which one partner has HSV-2 infection, suppressive antiviral therapy should be recommended for the partner with HSV-2 to reduce the rate of transmission.
- Topical antivirals are not effective in the treatment of genital herpes and should not be used.
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- Clinical suspicion of genital herpes should be confirmed using reliable laboratory testing.
- Discordant couples should be counseled that consistent use of condoms decreases but does not eliminate the risk of transmission.
Definitions:
Grades of Evidence
I: Evidence obtained from at least one properly designed randomized controlled trial.
II-1: Evidence obtained from well-designed controlled trials without randomization.
II-2: Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Levels of Recommendations
Level A — Recommendations are based on good and consistent scientific evidence.
Level B — Recommendations are based on limited or inconsistent scientific evidence.
Level C — Recommendations are based primarily on consensus and expert opinion.
